Dr. Jeff Hersh: Tinnitus is a symptom, not a disease

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Mar 13, 2014 at 12:32 AMMar 13, 2014 at 12:32 AM

By Dr. Jeff HershMore Content Now

Q: I have a ringing in my ears. Should I be concerned?A: The perception of a ringing, clicking, buzzing or other sound in the absence of an external source of noise, whether the sound is continuous or intermittent, and whether it is perceived in one or both ears, is call tinnitus. Tinnitus is actually a symptom, not a disease; there are many possible underlying causes, but in many cases, the cause is not identified. Tinnitus is extremely common; estimates are that it affects more than 50 million people in the U.S., about one out of every five people.The actual pathology of tinnitus is not well understood, but it is theorized that inadequate stimulation of the cochlea (the spiral organ in the ear responsible for sensing sound) or the cochlea nerve (which carries the signals from the cochlea) causes over-sensitization of the central nervous system that interprets sound (the auditory cortex), resulting in the inappropriate perception of sound.The character of the perceived sound can be a clue to a possible underlying cause:• Exposure to loud noises or ear trauma may cause high-pitched ringing sounds that resolve over hours to days. Long-term exposure to loud noises can make the high-pitched ringing permanent.• Hearing loss, for example associated with aging, can cause chronic high-pitched ringing/buzzing, typically in both ears. This is the most commonly identified cause of tinnitus.• An acoustic neuroma can also cause a high-pitched ringing sound, although usually only in one ear (on the side of the neuroma).• A swooshing or humming sound, especially if it changes with exercise or positioning, may be caused by abnormal flow through blood vessels by the ear (these may even be heard by the examining clinician).• Contractions of muscles close to the ears may cause a clicking sound, often coming in bursts lasting seconds to minutes.• Sounds that pulsate with heartbeats may be due to a blockage of the ear canal by wax, high blood pressure or certain vascular conditions.• A low-pitched ringing sound associated with vertigo (a spinning sensation) may stem from Meniere’s disease or other disorders.• Stiff inner ear bones may cause continuous or intermittent low-pitched ringing.• A scratchy sound can come from earwax or other foreign bodies rubbing against the eardrum.There are many other possible causes of tinnitus, including side effects of many medications, allergies, conditions of the jaw (such as temporomandibular joint conditions or TMJ) and others. In many cases no cause is identified.The severity of tinnitus varies greatly from patient to patient. For most patients, it is an annoying sound, which is more noticeable when it is quiet, such as at bedtime. Stress, smoking, caffeine and many other things may exacerbate symptoms. For about one in four patients, the severity of their tinnitus progresses over time.For some patients their tinnitus can be debilitating, interfering with their daily lives, making it difficult to sleep and/or causing significant psychological stress. The severity of a patient’s tinnitus may be evaluated the Tinnitus Reaction Questionnaire or other similar tools.Tinnitus is a symptom, not a diagnosis. Depending on what, if any, underlying diagnosis is suspected based on a detailed history and physical exam, tests may be ordered to look for an underlying condition. The most common test indicated is a hearing test, as hearing loss is the most commonly diagnosed cause. If a tumor or vascular cause is suspected, an imaging test, often an MRI, may be indicated.The first step in treating tinnitus is addressing any underlying cause. For example, earwax may be removed, hearing aids may be utilized to help improve hearing, blood pressure should be well controlled or rarely surgery may be indicated for tumors or certain vascular conditions. Depression or other associated conditions should be treated.For patients with severe tinnitus, whose symptoms persist despite treating any underlying conditions, therapy to minimize the clinical impact is indicated. This may include counseling, tinnitus retraining therapy, cognitive/behavioral therapy and/or biofeedback therapy. Masking devices that produce low-level sounds may help reduce a patient’s perception of their tinnitus, and electrical stimulus devices may play a role for some patients. Although there are no medications that specifically address tinnitus, antidepressants, seizure medications or other medicines may benefit select patients.People who experience tinnitus should see their health-care provider to be evaluated. For most people, this is a chronic but tolerable annoyance, but for those who have debilitating tinnitus, there are therapies that may help.Jeff Hersh, Ph.D., M.D., can be reached at DrHersh@juno.com.